The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Cut-Off Value and Factors Associated with a False Positive D-Dimer Result for Venous Thromboembolism in Koreans

한국인에서 D-Dimer의 위양성과 관련된 인자와 검사의 정확도 향상을 위한 Cut-Off Value

  • Hong, Man Yong (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Lee, Changkun (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Yoo, Sang-Yong (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Shin, Dae-Hee (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Cheong, Sang-Sig (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Kwon, Jang Hoon (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Jang, Woo Sung (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Yoo, Seung Jin (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Oh, Kwang Hoon (Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine)
  • 홍만용 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 이창근 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 유상용 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 신대희 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 정상식 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 권장훈 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 장우성 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 유승진 (울산대학교 의과대학 강릉아산병원 내과) ;
  • 오광훈 (울산대학교 의과대학 강릉아산병원 내과)
  • Received : 2012.07.30
  • Accepted : 2012.10.11
  • Published : 2013.03.01
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Abstract

Background/Aims: The D-dimer value is a simple blood test used to evaluate venous thromboembolism (VTE). However, due to its low specificity, another test is needed for a definite diagnosis, such as a radiographic test. We evaluate the factors associated with a false positive D-dimer test and propose a new cut-off value for detecting VTE more effectively in Koreans. Methods: This was a retrospective, observational study. From January 2009 to December 2009, 2,047 patients (988 men, 63 ${\pm}$ 15 years) had the D-dimer value checked to evaluate VTE. The main outcome of interest was a positive D-dimer test. Odds ratio and 95% confidence intervals were determined using logistic regression analysis. The new D-dimer cut-off was evaluated using receiver operating characteristics (ROC) curves. Results: The result was positive in 1,093 patients (53%), for a false positive percentage for VTE of 95% and a false negative percentage for VTE of 1%. Significant false positive predictors for a positive D-dimer were increasing age, trauma, postoperative, acute infection, tuberculosis, stroke, malignancy, chronic renal failure, acute coronary syndrome, heart failure, and lung disease. The discriminative value of the D-dimer test was assessed using ROC curve analysis. A D-dimer value of 0.68 mg/L on admission was the best cut-off value for predicting the development of VTE with a sensitivity of 95% and specificity of 57%. Conclusions: Many factors affect the D-dimer value and we must consider these factors before using the D-dimer value to evaluate VTE. A D-dimer value of 0.68 mg/L appears to be a good cut-off value for evaluating VTE more effectively in Koreans.

목적: 폐동맥 색전증과 심부 정맥 혈전증 이외에 D-dimer 검사의 양성 결과를 나타내는 여러 질환들이 보고되고 있으나, 현재까지 한국인에서 위양성을 유발하는 인자에 대해서는 명백하게 알려진 바가 없다. 따라서 한국인에서 위양성을 초래하는 인자들을 확인하고, 정확도를 향상시키기 위한 새로운 cut-off value를 제시하고자 한다. 방법: 2009년 1월부터 12월까지 본원에 방문한 환자 중 다양한 이유로 D-dimer 검사를 시행 받은 2,047명의 환자를 대상으로 분석하였고, 위양성을 유발하는 인자들을 확인하기 위해 오즈비와 95% 신뢰구간을 로지스틱 회귀분석을 이용하여 분석하였다. 새로운 cut-off value는 ROC curve를 이용하여 구하였다. 결과: 연령의 증가, 외상, 수술의 기왕력, 급성 감염, 결핵, 뇌혈관 질환, 악성종양, 만성 신부전, 급성 관동맥 증후군, 심부전, 호흡기 질환 등이 D-dimer 검사의 위양성을 유발하는 인자로 확인되었다. 또한 민감도와 특이도를 향상시키기 위해 ROC curve를 이용하여 구한 새로운 cut-off value는 0.68 mg/L였다(65세 이하에서는 0.58 mg/L, 65세 이상에서는 0.77 mg/L). 결론: 여러 인자들이 D-dimer 위양성과 관련이 있었으며, 임상에서 D-dimer 검사를 시행하고 임상에 적용할 때에는 이러한 인자들이 결과치에 영향을 줄 수 있음을 충분히 고려하여야겠다.

Keywords

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